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After
Starting HAART, Baseline HIV RNA Levels of 100,000 Copies/mL or
Greater Are Associated with Mortality
There
is conflicting evidence regarding the impact of baseline plasma
HIV
RNA on virologic responses after the initiation of
triple-drug HAART. This has made it difficult to interpret the recently
reported association between baseline plasma HIV RNA and mortality.
In
the current study, researchers evaluated whether baseline CD4 cell
count and plasma HIV RNA predicted virologic
suppression
(<500 copies/mL) and rebound (>=500 copies/mL) among
adherent
HIV patients.
Antiretroviral-naive
HIV-infected patients were stratified by baseline CD4
cell count, plasma HIV RNA, and adherence level. Cox and logistic regression were
used to evaluate the time to suppression and rebound and the odds
of ever achieving HIV RNA suppression.
Results
A
total of 1422 individuals initiated HAART between August 1, 1996
and July 31, 2000 and were followed to March 31, 2002.
Adherent
patients with HIV RNA levels >=100,000 copies/mL and 50 to 99,999
copies/mL were slower to suppress HIV RNA than patients with baseline
HIV RNA <50,000 copies/mL in Kaplan-Meier analyses.
Although
the odds of RNA suppression among adherent patients with baseline
RNA levels <50,000 copies/mL and 50 to 99,999 copies/mL were
similar (P = 0.197), patients with baseline HIV RNA >=100,000
copies/mL were markedly less likely ever to achieve suppression
during follow-up (P < 0.001).
No
differences in the rate of virologic rebound were observed between
adherent patients in the various baseline HIV RNA strata, and CD4
cell count was not associated with suppression or rebound.
In
conclusion, the authors write, “Baseline HIV RNA >=100,000 copies/mL
was associated with a significantly lower likelihood of ever achieving
HIV RNA suppression during follow-up.”
“These
findings likely explain the association between baseline HIV RNA
levels and mortality and have important implications for the development
of therapeutic guidelines.”
03/25/05
Reference
E
Wood and others. Journal of Acquired Immune Deficiency Syndromes
38(3): 289-295. March 1, 2005.
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